1841311230 NPI number — STELLAR REHABILITATION, LLC-WILLOW POINTE

Table of content: (NPI 1841311230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841311230 NPI number — STELLAR REHABILITATION, LLC-WILLOW POINTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STELLAR REHABILITATION, LLC-WILLOW POINTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841311230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1049 N EDGE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERONA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53593-1942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-845-2100
Provider Business Mailing Address Fax Number:
608-845-2101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 N EDGE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERONA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53593-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-845-2100
Provider Business Practice Location Address Fax Number:
608-845-2101
Provider Enumeration Date:
04/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARMSTRONG
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
608-845-2100

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9730-024 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: 3909-026 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 2089-154 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41224200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".